Allowing states to opt-out of Essential Health Benefits not only means a trend towards skimpier insurance plans (which is a de facto version of pre-existing conditions discrimination, if a plan is not available for you that covers the services needed for your pre-existing conditions). It introduces the return of annual and lifetime caps, since those bans under the ACA are based on what’s required to be covered under a fully functional Essential Health Benefits package. If a state, for instance, chooses to exclude prescription drug coverage under its EHB requirements, insurers can impose limits on those services.

And this potential effect goes beyond the individual market. Due to some quirks in the regulatory language surrounding the Affordable Care Act, if just one state anywhere scales back their EHBs, employer plans everywhere will be at risk for the return of lifetime and annual caps, and higher cost-sharing.

Loss of pre-existing condition coverage and renewal of caps on coverage are, effectively, death sentences from some chronically ill people.

PPS: Axios reports here that a bipartisan report from the association of state Medicaid directors opposes the health bill. The Association represents ALL Medicaid directors, including here in Trumpansas.

The spending growth rates for the proposed Medicaid per capita caps are "insufficient and unworkable," the directors wrote in a statement to be released Monday. While they say they support some elements included in the bill, "no amount of administrative or regulatory flexibility can compensate for the federal spending reductions that would occur as a result of this bill."

At last a recognition of the big rub. This bill reduces Medicaid spending. And block granting Medicaid with equal amounts per person will inflict disproportionate damage on Arkansas, which has benefitted richly from the Obamacare Medicaid expansion.

PS: A reduction over time in Medicaid will be devastating to the 400,000 Arkansas children covered by the program and some major facilities that service children, particularly Arkansas Children's Hospital, whose lifeline is Medicaid.